Lymphoma In Pregnancy Research Articles

A-142 Cutaneous T-cell lymphoma in pregnancy: disease activity and outcomes

A-142 Cutaneous T-cell lymphoma in pregnancy: disease activity and outcomes

Lymphomas in pregnancy.

Lymphoma in pregnancy is an uncommon occurrence. This diagnosis is challenging, and a multidisciplinary team of specialists in obstetrics, anesthesiology, neonatology, hematology psychology should participate in the management of this condition. The choice of treatment regimen depends on the histotype and the gestational age. In Hodgkin lymphoma, ABVD is safe if administered after the thirteenth week of pregnancy. In indolent non-Hodgkin Lymphomas (NHL) a watchful waiting approach is reasonable; in case of aggressive NHLs, if the diagnosis occurs in the first gestational weeks, a termination of the pregnancy might be considered or if it occurs after the thirteenth week of pregnancy, a standard R-CHOP regimen is safe. Regarding new anti-lymphoma drugs, available data on the potential fetotoxicity of these agents are limited. Data collection regarding the use of new drugs in pregnant patients is mandatory in order to learn more about their safety and facilitating clinical decision making in this setting of patients.

The clinical features, management and outcomes of lymphoma in pregnancy: A multicentre study by the Australasian Lymphoma Alliance.

Lymphoma in pregnancy (LIP) presents unique clinical, social and ethical challenges; however, the evidence regarding this clinical scenario is limited. We conducted a multicentre retrospective observational study reporting on the features, management, and outcomes of LIP in patients diagnosed between January 2009 and December 2020 at 16 sites in Australia and New Zealand for the first time. We included diagnoses occurring either during pregnancy or within the first 12 months following delivery. A total of 73 patients were included, 41 diagnosed antenatally (AN cohort) and 32 postnatally (PN cohort). The most common diagnoses were Hodgkin lymphoma (HL; 40 patients), diffuse large B-cell lymphoma (DLBCL; 11) and primary mediastinal B-cell lymphoma (PMBCL; six). At a median follow up of 2.37 years, the 2- and 5-year overall survival (OS) for patients with HL were 91% and 82%. For the combined DLBCL and PMBCL group, the 2-year OS was 92%. Standard curative chemotherapy regimens were successfully delivered to 64% of women in the AN cohort; however, counselling regarding future fertility and termination of pregnancy were suboptimal, and a standardised approach to staging lacking. Neonatal outcomes were generally favourable. We present a large multicentre cohort of LIP reflecting contemporary practice and identify areas in need of ongoing research.

Imaging evaluation of lymphoma in pregnancy with review of clinical assessment and treatment options.

Lymphoma-related malignancies can be categorized as Hodgkin's lymphoma (HL) or non-Hodgkin's lymphoma (NHL) based on histologic characteristics. Although quite rare during pregnancy, HL and NHL are the fourth and fifth most common malignancies during the pregnancy period, respectively. Given the rarity of lymphoma among pregnant patients, radiologists are usually unfamiliar with the modifications required for staging and treatment of this population, even those who work at centers with busy obstetrical services. Therefore, this manuscript serves to not only review the abdominopelvic imaging features of lymphoma in pregnancy, but it also discusses topics including birthing parent and fetal lymphoma-related prognosis, both antenatal and postpartum, current concepts in the management of pregnancy-related lymphoma, as well as the current considerations regarding birthing parent onco-fertility.

Capturing the lived experiences of women with lymphoma in pregnancy: a qualitative study

Lymphoma in pregnancy is a rare and challenging diagnosis that complicates ∼1:6000 pregnancies; posing a series of unique therapeutic, social, and ethical challenges to the patient, her family, and the medical professionals involved. These difficulties are compounded by the paucity of real-world data on the management of LIP, and a lack of relevant support systems for women in this setting. We conducted a retrospective multicenter qualitative study, interviewing women aged ≥18 years of age diagnosed with Hodgkin (HL) or non-Hodgkin lymphoma (NHL) during pregnancy or within 12 months postpartum, between 1 January 2009 and 31 December 2020 from 13 Australasian sites. Semi-structured telephone interviews were conducted, recorded, and analyzed using QSR Int NVivo 12 Pro (March 2020, USA) to quantify salient themes. Of the 32 women interviewed, 20 (63%) were diagnosed during pregnancy (16, 34, and 13% in the 1st, 2nd, and 3rd trimesters, respectively), while 12 (37%) were diagnosed post-partum. Women recalled that their chief concerns at diagnosis were the welfare of their child (n = 13, 41%) and a fear of dying (n = 9, 28%). Perceived diagnostic delay attributed to pregnancy was reported by 41% of participants. Other key themes were communication, educational materials, psychosocial supports, and oncofertility issues. To our knowledge this is the first report capturing the lived experiences of survivors of lymphoma during pregnancy, affording a unique opportunity to consider the management, psychosocial supports, and delivery of care to meet the needs of these women. What is the NEW aspect of your work? To our knowledge, this is the first report capturing and analyzing the healthcare experiences of survivors of Lymphoma in Pregnancy (LIP). What is the CENTRAL finding of your work? Women valued clear and empathic communication, provision of tailored educational materials, access to psychosocial supports (particularly childcare and financial supports), and timely oncofertility management in their healthcare journey. What is (or could be) the SPECIFIC clinical relevance of your work? Women’s personal accounts of positive and negative experiences of LIP care provide insights into their specific concerns and needs which can shape healthcare policy and development of a specific framework for managing and supporting patients with LIP (and other cancers).

TAMPONADE WAS ONLY A FACADE: CANCER WAS THE REAL ANSWER

TAMPONADE WAS ONLY A FACADE: CANCER WAS THE REAL ANSWER

138 Primary mediastinal large b cell lymphoma in pregnancy: How to deal with it?

Introduction: Primary mediastinal large B cell lymphoma (PMLBCL) is a rare condition but one of the most common hematologic malignancies, particularly in reproductive age women. There are a few cases reported in literature and for that reason there is no clear evidence for its management in pregnancy. We aim to share this clinical case with medical community and to expand knowledge on this rare entity. Aims and Methods: We describe the case of a 35 year-old woman diagnosed with PMLBCL at 23 weeks of pregnancy.

Single Abscess as the First Manifestation of Breast ALK-Positive Anaplastic Large Cell Lymphoma in Pregnancy Without Breast Implants: A Case Report

Primary lymphoma involving the breast accounts for only 0.04–0.5% of malignant breast tumors, constituting 1–2 % of all non-Hodgkin lymphomas (NHL). Here, we report a case of breast ALK-positive ALCL arising in a 21-year-old woman in pregnancy with single abscess as the first clinical manifestation.

Lymphoma during Pregnancy: A Multicentre Study By the Australasian Lymphoma Alliance

IntroductionLymphoma complicates approximately 1/6000 pregnancies (Pereg, Haematologica 2007), and presents challenges for the patient, her family, and medical professionals. This rare event raises unique therapeutic, social and ethical issues, with the welfare of both mother and unborn child to consider. There are challenges regarding symptom obfuscation, diagnosis delays and treatment delivery. In this retrospective study, we aimed to describe the experience, treatment patterns and outcomes of lymphoma in pregnancy in Australia and New Zealand.MethodsWe identified patients aged ≥18 diagnosed with lymphoma in pregnancy between 1 January 2009 and 31 December 2020 , across 11 institutions in Australia and New Zealand. We defined “lymphoma in pregnancy” as diagnoses occurring during pregnancy (antenatal cases) or the first 12 months after delivery (postpartum cases). Postpartum cases were included to account for the phenomenon of diagnostic delay during gestation due to deferral of diagnostic investigations and symptom obfuscation (de Haan, Lancet Oncol 2018). Overall survival was calculated by Kaplan-Meier methods from the date of diagnosis to death, with patients alive and lost to follow-up censored on the last day of follow-up.ResultsWe identified 63 patients, 34 diagnosed antepartum and 29 diagnosed postpartum (Table 1). The most common diagnoses were classical Hodgkin lymphoma (HL) (35), followed by diffuse large B cell lymphoma (11) and primary mediastinal B cell lymphoma (6). The median age was 32 (range 23-42) years. Women diagnosed antepartum were more likely to be nulliparous (p=0.004). Of the postpartum cases, symptoms of malignancy first appeared during pregnancy in 24%.At diagnosis, 44% had advanced stage disease. 60% of women had PET as part of baseline staging, however only 8% underwent PET whilst pregnant, all during the second or third trimester. 83% of HL patients had adverse risk factors (mediastinal bulk >1/3 diameter, ESR>50mm/hr, >2 sites). ESR alone, which may be elevated physiologically in pregnancy, was the sole adverse risk factor for 9% of HL patients.Median days between diagnosis and treatment initiation were 14 (IQR 8-30) for antenatal patients and 21 (IQR 7-40) for postnatal. 19% of the antenatal cohort with aggressive lymphoma had treatment deferred/delayed explicitly due to pregnancy. The majority (89%) of antenatal patients were treated with ABVD (HL) or (R)CHOP/(R)EPOCH (NHL) whilst pregnant. 3 patients received first-line treatment divergent from standard (vinblastine for HL, interferon for indolent B-NHL and surgery for primary cutaneous ALCL). 37% received radiotherapy, although only 1 patient received it antenatally.Median follow up was 34 months. 5 year OS for HL was 83% (95%CI 54%-95%) and for DLBCL 74% (95%CI 30%-93%)(Figure 1). Seven patients died (4 from lymphoma, 2 treatment-related infection, 1 unknown).Discussion of elective termination of pregnancy was documented in 24 of 34 antenatal diagnoses, advised in 3 and performed in 2, both in the first trimester. Only 31 (49%) of 63 women had documented evidence of counselling regarding future fertility strategies.Of the 48 patients with available data, there were 45 live births, 2 elective terminations and 1 spontaneous abortion in the first trimester. The mean gestation at birth was significantly earlier and marginally preterm for antenatal diagnoses (mean 35.6wk v 38.2wk, p=0.002). 6 neonates (11%) were small for gestational age, 5 of whom were born to mothers diagnosed antenatally. 29% of neonates were admitted to neonatal intensive care or special care units. There were no cases of neonatal neutropenia, one case of sepsis of prematurity and one case of PJP infection in a term baby.ConclusionLymphoma in pregnancy is rare and lacks a harmonised approach. We present a large multicentre cohort reflecting contemporary practice. Although standard therapy could be provided to most patients, delays in treatment and diagnosis were common, and most antenatally-diagnosed women did not receive optimal staging. Neonates in the antenatally-diagnosed group were more likely to be premature, however there are likely a number of confounders and causality cannot be presumed. There were no neonatal deaths. It is imperative to continue to report on data regarding lymphoma in pregnancy to inform optimal care in this setting. [Display omitted] DisclosuresGreenwood: Amgen: Membership on an entity's Board of Directors or advisory committees, Research Funding; Pfizer: Membership on an entity's Board of Directors or advisory committees; Servier: Membership on an entity's Board of Directors or advisory committees, Research Funding; Jazz Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees. Gregory: Janssen: Consultancy; Novartis: Consultancy; Roche: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel fees, Speakers Bureau. Hamad: Novartis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau.

Capturing the Lived Experiences of Women with Lymphoma in Pregnancy: An Australasian Lymphoma Alliance Study

Background: Lymphoma in pregnancy is a rare and challenging diagnosis that complicates approximately 1:6000 pregnancies. Diagnostic delay occurs frequently, as lymphoma-related symptoms may be mistakenly attributed to the pregnancy itself, and diagnostic investigations postponed or omitted. Lymphoma in pregnancy poses a series of unique therapeutic, social, and ethical challenges to the patient, her family, and the medical professionals involved. This is largely due to a paucity of published management guidelines, with current evidence based on modest case series and expert opinion. In this study we endeavoured to understand women's lived experiences during this challenging time. We performed semi-structured interviews with women previously treated for lymphoma in pregnancy, to identify both gaps in care delivery and valued interventions with the aim of informing future models of care.Methods: We retrospectively identified patients from twelve sites in Australia and New Zealand aged ≥18 years of age diagnosed with Hodgkin (HL) or non-Hodgkin lymphoma (NHL) during pregnancy or within 12 months postpartum, between 1 January 2009 and 31 December 2020. Baseline demographic characteristics, treatment details, and outcomes were collected, and semi-structured interviews were conducted via telephone with those who provided informed consent. Thematic analysis was performed using QSR Int NVivo 12 Pro (March 2020, USA) to quantify salient themes. The initial 5 transcripts were independently coded by two investigators who then reached a consensus on pre-determined codes. These codes were applied to the rest of the transcripts by one coder. The frequency of pre-determined themes was determined via descriptive statistics.Results: A total of 29 women were interviewed. Baseline demographic characteristics are documented in Table 1. The majority were diagnosed during pregnancy (14%, 28% and 17% in the 1 st, 2 nd and 3rd trimesters respectively), while 41% were diagnosed post-partum. HL was the most frequent diagnosis (48%) followed by diffuse large B cell lymphoma and primary mediastinal lymphoma (14% each). More than 90% of women received chemotherapy with 28% receiving combined modality chemoradiotherapy. Sixty-nine percent commenced chemotherapy during pregnancy (17%, 28% and 14% in the 1 st, 2 nd and 3rd trimesters respectively) and 41% commencing postpartum. In the 28% of patients who received radiotherapy, this was administered post-partum.A summary of themes identified and their frequency across the 29 transcripts are shown in Figures 1-3. Diagnostic delay attributed to pregnancy was reported by 41%. 21% of the women reported fatigue, breathlessness, weight change and musculoskeletal pain, which they felt healthcare practitioners found difficult to interpret in the context of pregnancy/postpartum period. Women recalled that their chief concerns at diagnosis were the welfare of their unborn child (41%) and a fear of dying (27%). Over half of the women (55%) reported perceived communication breakdown between health practitioners and patients. They also felt there was a lack of sensitivity in discussions around fertility preservation (45%), teratogenicity of treatment (31%), termination of pregnancy (14%) and cessation of breast-feeding (14%). Valued interventions included financial/logistic assistance from charity organisations (48%), a personal support network (45%), clinical psychology referral (31%) and emergency childcare (10%). Patients also found shared patient experiences (31%) and support groups (17%) beneficial in their treatment journey.Conclusion: To our knowledge this is the first report capturing the lived experiences of survivors of lymphoma during pregnancy. This provides us a unique opportunity to consider our management, psychosocial supports, and delivery of care to meet the needs of these women. Areas for development in future care models include increased patient advocacy, educational materials, economic, psychosocial, and childcare supports. Above all, there is scope for improved, tailored communication between health practitioners and patients, with sensitivity around embryotoxicity, pregnancy termination and adverse outcomes to foster autonomy, build trust and improve maternal wellbeing. [Display omitted] DisclosuresGreenwood: Jazz Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees; Servier: Membership on an entity's Board of Directors or advisory committees, Research Funding; Pfizer: Membership on an entity's Board of Directors or advisory committees; Amgen: Membership on an entity's Board of Directors or advisory committees, Research Funding. Gangatharan: Astrazeneca: Other: Educational Conference Funding. Hamad: Novartis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau.

UNEXPECTED CAUSE OF POSTPARTUM CARDIAC ARREST: PRIMARY MEDIASTINAL LARGE B-CELL LYMPHOMA

TOPIC: Disorders of the Mediastinum TYPE: Medical Student/Resident Case Reports INTRODUCTION: Lymphoma is the fourth most common malignancies in pregnancy, and a high portion is primary mediastinal (thymic) large B-cell lymphoma (PMBCL). It presents many challenges to diagnose lymphoma during pregnancy while avoiding fetal harm. CASE PRESENTATION: 41-year-old G2P1 female without significant past medical history experienced shortness of breath starting in her second trimester. She only had a telehealth appointment amid the COVID19 pandemic. The patient was offered a chest X-ray (CXR) but declined due to her concern of radiation. She was empirically managed as asthma triggered by acid reflux. At 39W of gestation, she presented to the hospital for labor and delivery. She was hypoxic and required three liters of oxygen. The physical exam was unremarkable. Lab were pertinent for mild leukocytosis and anemia. The patient still declined CXR. She was taken for C-section after failing trial of vacuum. The newborn was healthy. After delivering, she developed profound hypoxia in the OR requiring intubation. Tracheal compression was noted during intubation. CXR after intubation showed mediastinal widening. Following intubation, patient developed tachycardia, hypotension and ultimately cardiac arrest requiring CPR. Extracorporeal membrane oxygenation was activated. CT angiogram of the chest showed a 15 cm x 12 cm x 13 cm mass in the superior mediastinum that encases the aorta and great branches and was associated with direct extension into the sternum and invasion of the pericardium. The tumor also encased the trachea and left main bronchus. During her hospitalization, no neurological recovery was observed. The family decided to transition to comfort. The patient unfortunately passed away. The autopsy revealed neoplastic medium to large-size lymphoid cells in mediastinal mass, positive for CD45, CD20, BCL2, PAX-5, MUM-1, and MYC rearrangement negative for other markers. The final diagnosis was PMBCL. DISCUSSION: PMBCL is an aggressive B cell lymphoma arises from the thymus. Airway obstruction and superior vena cava syndrome are common due to local invasion. Dyspnea, B symptoms (fever, night sweats, weight loss) are possible symptoms. Labs may reveal elevated lactate dehydrogenase. Imaging studies typically illustrate an anterior mediastinal mass originating in the thymus. Final diagnosis can be made with biopsy and immunohistochemistry or flow cytometry analysis. Early recognition is important since these patients are at risk of cardiac and respiratory arrest during general anesthesia due to the mass location in the mediastinum. Pregnant patients should be informed that there is no evidence of fetal adverse outcome with imaging studies that expose the fetus to less than 50 mGy (CXR fetal dose: 0.0005 to 0.01 mGY). CONCLUSIONS: PMBCL should be identify early in pregnancy due to increased risk of cardiac and respiratory arrest. CXR is safe and harmless to the fetus. REFERENCE #1: Brenner B, Avivi I, Lishner M. Haematological cancers in pregnancy. Lancet. 2012;379(9815):580-587. REFERENCE #2: Dunleavy K, McLintock C. How I treat lymphoma in pregnancy. Blood. 2020 Nov 5;136(19):2118-2124. doi: 10.1182/blood.2019000961. PMID: 32797210. REFERENCE #3: Brent RL. The effect of embryonic and fetal exposure to x-ray, microwaves, and ultrasound: counseling the pregnant and nonpregnant patient about these risks. Semin Oncol. 1989 Oct;16(5):347-68. PMID: 2678486. DISCLOSURES: No relevant relationships by John Chronakas, source=Web Response No relevant relationships by Patrice Gillotti, source=Web Response No relevant relationships by Tien-Chan Hsieh, source=Web Response No relevant relationships by Oluwaseyi Olayinka, source=Web Response No relevant relationships by Nusrat Pathan, source=Web Response No relevant relationships by Akash Shah, source=Web Response No relevant relationships by Amanda Tissot, source=Web Response

Pearls & Oy-sters: Primary CNS Burkitt Lymphoma in Pregnancy

Primary CNS lymphoma (PCNSL), albeit rare in pregnancy, needs to be considered in the differential diagnosis of neurologic deficits with multifocal brain lesions.

Management of patients with lymphoma in pregnancy

Management of patients with lymphoma in pregnancy

Hodgkin lymphoma in pregnancy: good news for clinicians and women

Hodgkin lymphoma in pregnancy: good news for clinicians and women

Primary Mediastinal T-Cell Lymphoma in Pregnancy

Primary Mediastinal T-Cell Lymphoma in Pregnancy

Hodgkin lymphoma in pregnancy - current management practice based on case report series.

Hodgkin lymphoma in pregnancy - current management practice based on case report series.

Whole-body MRI is a powerful aid in differential diagnosis and multidisciplinary management of lymphoma in pregnant women

Introduction: Lymphoma is one of the most common malignancies associated with pregnancy. The clinical manifestations of lymphoma can be extremely diverse. Timely diagnosis and appropriate management of lymphoma in pregnancy can achieve good long-term outcomes for both the mother and fetus.

Anaplastic large cell lymphoma in pregnancy. A case report

Anaplastic large cell lymphoma in pregnancy. A case report

Hodgkin lymphoma in pregnancy

Hodgkin lymphoma in pregnancy

Is Cytology Safest Modality Available in Armamentarium for Diagnosis of Hodgkin’s Lymphoma in Pregnancy?

Hodgkin’s lymphoma (HL) is one of the curable diseases in pregnancy. Since pregnant females are immuno-compromised, so it is important to know about the course and progression of this common entity in pregnancy. Fine needle aspiration cytology is minimally invasive and a safe approach to diagnose and subtype such cases as early diagnosis and effective treatment will lead to better outcome of the mother and fetus. Here we present a case of nodular sclerosis Hodgkin’s lymphoma in a pregnant female diagnosed on cytology with histopathological confirmation and immuno-histochemical analysis.